回声跟踪技术评价原发性甲减患者甲状腺素治疗前后颈动脉弹性变化

摘要

Objective To detect the change of early carotid artery elasticity before and after levothyroxine therapy in primary hypothyroidism patients by using EchoTracking(ET) technique. Methods Eighty-six primary hypothyroidism patients and fifty healthy subjects (control group) were enrolled in this study. All patients were examined before and after levothyroxine treatment, Carotid vascular intima thickness (IMT), stiffness parameter ((3), pressure strain elasticity modulus ( Eρ), arterial compliance ( AC), argumentation index(AI)and one-point pulse wave velocity (PWVβ) of these arteries were measured using Color Doppler Ultrasound. Results (1) IMT,β,Eρ, PWVβ of carotid arteries were significantly higher and AC was significantly lower(P<0. 05) in the hypothyroidism group than those in the control group,but AI had no statistical significance(P>0. 05). The positive correlation was found between IMT and β,Ep,PWVβ(r=0. 615, r=0.587,r=0. 591, P<0. 05 ) , The negative correlation betweenIMT and AC(r = — 0. 541, P<0. 05). (2) After treatment,the TSH,TC,LDL concentrations decreased in both groups of primary hy-pothyroidism(P<0. 05),FT3,FT4 was significantly lower(P<0. 05). (3) After treatment, the β,Ep,PWVβ concentrations lower , AC was significantly higher(P<0. 05) in the hypothyroidism before treatment group than those in the aftert reatment group,but IMT and AI had no statistical significance(P>0. 05). (4) After the treatment, the absolute changes of the TSH showed positive correlation with the changes of β,Eρ, PWVβ(r=0. 497,r=0. 504,r=0. 576,P< 0. 05), The negative correlation between TSH and AC( r= — 0. 449 , P<0. 05). Conclusions The carotid artery elasticity in primary hypothyroidism patients was significantly lower than those in the control group; which improved after thyroxine treatment. ET technique may provide the basis for effectiveness of thyroxine therapy.%目的 探讨回声跟踪技术(echo-tracking,ET)评价原发性甲状腺功能减退症(甲减)患者左旋甲状腺素治疗前后颈动脉弹性变化特征.方法 选择确诊的原发性甲减患者86例及50例作为正常对照组,患者采用左旋甲状腺素进行治疗,治疗前及治疗后应用彩色多普勒超声诊断仪测量颈动脉内-中膜厚度(IMT)、硬化参数(β)、血管压力应变弹性系数(Eρ)、血管顺应性(AC)、脉搏波增大指数(AI)及单点脉搏波传导速度(PWVβ)等参数.结果 (1)与对照组比较,原发性甲减组IMT、β、Eρ和PWVβ明显升高,AC显著减低(P＜0.05),AI无显著性差异(P＞0.05)；IMT与β、Eρ、PWVβ呈显著正相关(r=0.615、r=0.587、r=0.591,P＜0.05),与AC呈负相关(r=-0.541,P＜0.05).(2)与治疗前比较,治疗后促甲状腺激素(TSH)、总胆固醇(TC)、低密度脂蛋白(LDL)明显降低(P＜0.05),游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)增高(P＜0.05).(3)与治疗前比较,治疗后β、Eρ、PWVβ值明显降低,AC明显增高,差异有显著性(P＜0.05),IMT、AI两组比较无显著性差异(P＞0.05).(4)原发性甲减治疗前后TSH的变化与β、Eρ、PWVβ的变化呈正相关(r=0.497、r=0.504、r-0.576,P＜0.05),与AC呈负相关(r=-0.449,P＜0.05).结论 原发性甲减患者颈动脉弹性降低,甲状腺激素补充治疗可改善血管弹性.ET技术可作为甲状腺素治疗疗效的检测手段.